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<br /> NON - COLLUSION AFFIDAVIT
<br /> O `'^ `^—�. City of Sunny Isles Beach
<br /> ® ',,� ` ',
<br /> c„ 18070 Caim Avenue
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<br /> Sunny Irks Beam.FL 33180
<br /> O Telephone:(305)947-06136 Fac(305)9193113
<br /> STATE OF FLORIDA
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<br /> COUNTY OF yC1Q2 1
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<br /> OThe undersigned being first duly sworn as provided by law,deposes,and says:
<br /> ® This Affidavit is made with the knowledge and intent that it is to be filed with the Crty of Sunny Isles Beach City Commission and that a will be
<br /> relied upon by said County,in any consideration which may give to and any action rt may take with respect to this Bid.
<br /> The undersigned is authorized to make this Affidavit on behalf off,
<br /> O ,c41-15c- N ,,//'r1t n,ti<vf f orhto4vv) Ca)iv
<br /> (Name of Corporation,Partnership,Individual,etc.)
<br /> O a, eink.S U 141 tic ,formed under the laws of Fi_
<br /> ® (Type of Business, (State)
<br /> O ofwhich hes Sa (E QEu,Iw,.r
<br /> (Sole Owner,Partner,President,etc.)
<br /> ® Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knovAedge of the
<br /> undersigned,have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City,also that no head of any
<br /> department or employee therein,or any officer of the Crty of Sunny Isles Beach,Florida is directly interested therein.
<br /> O This Bid is genuine and not collusive or a sham;the person,fun or corporation named above in Paragraph 10.2 has not colluded,conspired,
<br /> coruuved or agreed directly or indirectly with any proposers or person, fun or corporation,to put in a sham Bid, or that such person firm or
<br /> ® corporation shall refrain from Bidding,and has not in any manner,directly or indirectly,sought by agreement or collusion,or communication
<br /> ® or conference with any person,rum or corporation,to fa the prices of said Bid or Bids of any other proposers;and all statements contained in
<br /> the Bid or Bids described above true;and further, neither the undersigned, nor the person, fine or corporation named above in Paragraph
<br /> 10.2,has directly or indirectly submitted said Bid or the contents thereof,or divulged information or data relative thereto,to any association or
<br /> ® to any/ member or agent thereof.
<br /> ® Al Se . Hari nap" d
<br /> AFFLr re✓
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<br /> ME IANTS TITLE
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<br /> O TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this ori day of 1110.41_, ,20013„
<br /> ® Personally Known I✓ or Produced Identification
<br /> Type of identification
<br /> ® (Affa seal here) Q /
<br /> O ARY PUBUC(name printed or typed) ,
<br /> O C Notary Punk Stab of Florida
<br /> Zenaida Fernandez
<br /> , My Cammissian lE 15760.1
<br /> (YY� ?e, Errpiao1il72d16
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<br /> • Curtis ± Rogers Design Studio RFQ 12-04-02 54
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